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Dec 8, 2018 at 7:16 PMDec 8, 2018 at 7:48 PM

The number of students in Volusia and Flagler counties who are going to school without being fully vaccinated is on the rise — up more than 800 percent over 15 years. And though the totals remain few, the numbers are great enough to concern health officials, who fear an outbreak of chickenpox, measles or other diseases.

An increasing number of parents are getting religious exemptions for their child — the one-page form is the only way to permanently avoid the immunization requirements in Florida without a medical reason — even though no major religion takes a position against vaccines.

"That's very concerning," said Dr. Ashwini Jasutkar, a pediatrician at Florida Hospital Memorial Medical Center in Daytona Beach. "Our hope is that the community in general gets vaccinated to protect those kids who can't (because of allergies or other conditions). That rise poses a huge public health risk."

Despite recommendations from medical authorities and the government that children be vaccinated on a specific schedule in infancy and early childhood, parents like South Daytona resident Elizabeth Symons are making the choice to follow their gut instead of the large body of medical advice.

“It is the workaround,” Symons said of seeking the religious exemption. “It’s the only way to have your child continue going to public school and be able to be exempt from the requirement of vaccinations.”

But it’s a workaround that may be putting others in the community at risk. The growing number of families that opt to go that route worries health care providers like Jasutkar and Denise Ayers, the nursing director for the Florida Department of Health in Volusia.

When more and more of the population isn’t getting vaccinated, that increases the risk for more vulnerable groups — anyone from newborns, to the elderly, to people with autoimmune deficiencies. When a certain threshold of the population is vaccinated, they provide herd immunity, or "community immunity," as Ayers likes to say, that helps protect everyone.

“As a community, we’re not protecting ourselves,” Ayers said. “We’re not good stewards of our own health care. And as such, we put others at risk.”

A distrust of vaccines

The arguments against vaccines are many and varied. Some parents think they can cause autism. Some take issue with the ingredients and worry about the use of mercury as a preservative. Some think kids get too many at once.

But according to the Centers for Disease Control and Prevention, vaccines don’t cause autism, and neither do their ingredients. The preservative used in some vaccines, thimerosal, does not cause any harm, but it was taken out of childhood vaccines in 2001 anyway. And the recommended vaccination schedule does not cause chronic health problems. Altering it can make children vulnerable to disease for longer.

Parents like Symons are still skeptical.

Her son received some vaccinations as an infant, but stopped at the MMR vaccine — measles, mumps, rubella. Another family member was diagnosed with autism shortly after receiving the same vaccine, and Symons said it wasn’t worth the perceived risk for her.

“There are plenty of studies out there that say there is absolutely no correlation, but how can we be so sure with the rise in autism rates?” she said.

Although the number of parents who think like Symons does is ostensibly on the rise, a 2016 study by the nonpartisan Pew Research Center showed that the majority of Americans still believe the benefits of vaccinations outweigh the risks and support a school-based requirement for the MMR vaccine.

The MMR vaccine was specifically, and falsely, linked to autism two decades ago in a now-retracted and discredited research study. It’s also what celebrity Jenny McCarthy blamed for her son’s autism diagnosis in her 2007 book.

But despite the lack of scientific evidence connecting autism and vaccinations, the same Pew study showed that parents of children 4 years old or younger — the ones being vaccinated at the highest rate — are more concerned. Sixty percent of parents of those young children think the preventative benefits of the MMR vaccine are high. In comparison, 76 percent of people with no children under 18 think the benefits are high.

Pew also found that younger adults were more skeptical: 90 percent of adults 30 and older said vaccines were safe for healthy children, but only 79 percent of those ages 18-29 said they were safe.

A change over time

Hand-in-hand with that skepticism is the growing rate of religious exemptions given out in Florida.

Both Volusia and Flagler counties have seen a boom in religious exemptions that exceeds the state’s rate, and it comes at a time when Americans are, as a whole, becoming less affiliated with religion. And research studies have shown that major religions do not take a position on vaccinations in any canonical doctrine.

In 2002 in Volusia County, 0.4 percent of kindergartners had religious exemptions that said they didn’t have to be vaccinated to go to public and private schools. That year, that was 21 students, according to records from the state health department. In 2017, the rate rose by 825 percent to 3.3 percent — 159 students.

In Flagler, the jump was even higher, from 0.5 percent with religious exemptions in 2002, to 6 percent in 2017, a 12-fold increase. That makes Flagler's rate second only to Sarasota County among Florida's 67 counties.

The figures include both public and private school students, though when you look at just private schools, the rate of religious exemptions for kindergartners last year is about four times what it is in public schools in both counties.

While the totals are small, they are enough in some cases to prevent communities from maintaining a high enough rate of vaccination to create the "community immunity" medical experts seek. In Florida, less than half of counties achieved or exceeded the goal of 95 percent immunization among kindergartners. The state’s rate of exemptions, including medical exemptions, is at 6.2 percent. Religious exemptions account for 2.4 percent, enough to drop the state below its 95 percent target.

In Volusia, 93 percent of students have the required immunizations; in Flagler, 92 percent.

The very success of vaccination programs may be partially responsible for the increase in some parents opting out, Ayers and Jasutkar said. Now that the diseases the vaccinations protect against are all but eradicated in the U.S., people don’t know anyone who has had mumps, or measles or tetanus.

"They have this happy, healthy baby and they don't know what the risk is because they haven't seen measles in their lifetime," Jasutkar said. "These illnesses can be deadly."

The recommended vaccination schedule means that by the time children reach kindergarten, they need four or five doses of DTap (for diphtheria, tetanus and whooping cough), four or five doses of IPV (for polio), two doses of MMR, three doses of Hep B (for hepatitis), one Tdap (tetanus, diphtheria and whooping cough), and two doses of the chickenpox vaccine (unless the child has already had the disease). Children who go to daycare or preschool must be vaccinated before kindergarten, and everyone must receive another tetanus shot before seventh grade.

“It’s based in science,” Ayers said of the schedule and the requirements. “It’s based in outbreaks and incidence of disease.”

Outbreaks are popping up in the U.S. more frequently. A school in North Carolina where many families claim religious exemptions is facing an outbreak of the chickenpox, with more than 36 cases reported in November. By August, more than 100 cases of the measles were reported in 21 states. That’s up from recent years, but still not close to 2014’s total when a single outbreak that likely started from an unvaccinated traveler at Disneyland in California in December spread to multiple states and 147 people.

Symons said the fact that vaccine-preventable diseases are rarely seen anymore in the U.S. is something that soothes her worries.

“It makes me feel more comfortable, that a lot of these diseases aren’t widespread, we don’t see them a lot,” she said. “I also know that with the medical advancements we have now, that if (my son) did get sick that modern medicine would be able to treat him.”

For Symons, who isn’t completely against vaccines but would like to see an improvement in their ingredients, it comes down to autonomy.

“I just really advocate for being able to make a decision that vaccines shouldn’t be something that we have to do,” she said. “We should all have the decision to choose whether or not we vaccinate our children.”

Jasutkar agrees that a parent's ability to choose what's best for kids is vital but said she works to educate parents about what that choice means. She, Ayers and the CDC emphasize that it's a decision that can have real consequences and could quickly amount to a public health crisis in local schools.

"If it were up to me, I'd want (the percent of immunized students) to be up to 99.9 percent," Jasutkar said. "The bigger risk is the choice or decision not to vaccinate your child."